Sepsis, often referred to as blood poisoning, occurs when the body overreacts to an infection.
Typically, the body's immune system will fight it off, but severe sepsis can lead to widespread inflammation and blood clotting, and eventually to organ failure and death. Critically ill patients, as well as those with chronic diseases and compromised immune systems, are at particularly high risk of developing the condition.
It's estimated that sepsis strikes 750,000 patients each year in the United States and that number could rise to 1 million by 2010, according to the Surviving Sepsis Web site (www.survivingsepsis.org), a partnership of the Society of Critical Care Medicine, the European Society of Intensive Care Medicine, and the International Sepsis Forum. Mortality rates for patients suffering from severe sepsis are 30% to 50%, and it's estimated that U.S. hospitals spend $17 billion a year treating the condition.
Change Of Focus
St. Vincent's Hospital for years had procedures in place to detect and treat sepsis, but combating the condition is difficult because clinicians have to stay focused on treating patients for the condition that brought them to the hospital, says Michelle Lecardo, R.N., critical care educator in the critical care department at the Bridgeport, Conn.-based hospital.
Detecting sepsis requires monitoring for a complex set of symptoms, and often a diagnosis comes too late. "By the time patients are exhibiting initial signs of sepsis they may already be experiencing organ failure," she says.
To get ahead of that curve, St. Vincent's Hospital last August deployed ProtocolWatch, a decision support system from Philips Medical Systems, Andover, Mass., that integrates with the hospital's monitoring hardware.
St. Vincent's already was using Philips' monitoring technology when Lecardo saw a ProtocolWatch demo at a Society of Critical Care Medicine conference. The hospital received a $10,000 grant from Philips to deploy the system. Lecardo declined to say how much the implementation cost beyond the initial grant.
Harmonization Of Hardware, Software
The software integrates with the monitoring hardware that is used to observe a patient's electrocardiogram, blood pressure, oxygen saturation and respiratory rate. The monitor can also be used to watch the patient's temperature if they have a Foley catheter, a latex tube inserted into the bladder to drain urine, in place. It also can gather additional cardiac information if the patient has a central line catheter.
St. Vincent's upgraded and replaced monitors to enable touch screens to be used by clinicians accessing the software. ProtocolWatch is available on 34 monitors, 26 in the intensive care unit and eight in the emergency department.
Whenever a patient is admitted to St. Vincent's intensive care unit, they are placed on one of the monitors. Patients admitted to the emergency department who are suffering from respiratory distress or other symptoms that raise a red flag also are hooked up to a ProtocolWatch-enabled monitor.
The monitors display pop-up windows that lead clinicians through a series of questions that help determine whether the patient is at risk of sepsis. Nurses enter information using the touch screen display.
Something as simple as a fever, combined with other data collected by ProtocolWatch, can trigger a request that the nurse check the patient's serum lactate level, a key indicator of whether the patient is developing sepsis.
If the lactate level is over a certain number, the nurse immediately will start the sepsis care schedule, or bundle, that can include a broad-spectrum antibiotics treatment or a variety of other treatments, depending on the test results.
"Once it comes back positive you typically only have six hours before organ dysfunction," Lecardo says. "When you see the different questions on the display it helps you become more aware of what's going on." The system also will ask for checks on indicators such as white blood count or blood glucose level.
St. Vincent's had a sepsis care schedule in place before deploying ProtocolWatch, but the decision support software has made it easier to systematically check for the condition, Lecardo says. It's also led to changes in other procedures to quicken the pace of identification and treatment of sepsis.
For example, serum lactate levels previously would have to go to the lab, but now the test is done at the bedside to enable quicker results, Lecardo says. Also, all ICU patients now receive Foley catheters with temperature sensors so that they can be monitored at all times. "This one software program has led us to look at our overall processes and implement changes that increase awareness of sepsis," she says.
St. Vincent's is studying the impact of ProtocolWatch, Lecardo says. Nurses are reviewing 50 charts pre-implementation and a similar number post- implementation to identify any variances in how patients were treated. St. Vincent's does have an electronic health record, but clinicians still chart on paper in the ICU and the information is later entered into the EHR.
Greater Knowledge
The focus on preventing sepsis in the ICU and ED has caused greater awareness in other areas of the hospital too, Lecardo says. Even though the Philips monitors won't be used throughout the hospital, the sepsis care schedule is being rolled out and other caregivers are being educated about sepsis symptoms.
"Six months ago you wouldn't have heard about sepsis, but now everybody is talking about it," Lecardo says.
Decision support systems like ProtocolWatch are starting to attract attention from hospital I.T. leaders because of their significant clinical and financial benefits, says Todd Frech, a senior partner at Ocius Medical Informatics, a Ravenel, S.C.-based consulting firm.
A recent decision by the Centers for Medicare & Medicaid Services to not reimburse for certain medical errors has lent a sense of urgency to incorporating decision support into care delivery.
Treatment for cases involving objects left in patients during surgery, air embolisms, blood incompatibility, catheter-associated urinary tract infections, pressure ulcers, vascular catheter blood stream infections, surgical site infections and injuries from falls will no longer be reimbursed by CMS this year.
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